Assessing the impact of a national clinical guideline for the management of chronic pain on opioid prescribing rates: A controlled interrupted time series analysis

Abstract

Background: Opioids are used to treat patients with chronic pain, but their long-term use is associated with harms. In December 2013, SIGN 136 was published, providing a comprehensive evidence-based guideline for the assessment and management of chronic pain in Scotland. Aims: This study aimed to examine the impact of SIGN 136 on opioid prescribing trends and costs across the whole of Scotland. Methods: Opioid prescribing data and average cost per item were obtained from Public Health Scotland. An interrupted time series analysis examined the effects of SIGN 136 publication on the number of items prescribed per 1,000 population per quarter for 29 opioids (or opioid-containing combinations) from 2005 to 2019 inclusive. Exploratory analysis was conducted in NHS Tayside and NHS Fife combined and then up-scaled to all 14 NHS Scotland health boards. A similar approach was also used to assess the effect of SIGN 136 on estimated gross ingredient costs per quarter. Results: At six years post-intervention there was a relative reduction in opioid prescribing of 18.8% (95% CI: 16.0-21.7) across Scotland. There was also a relative reduction of 22.8% (95%: 14.9-30.1) in gross ingredient cost nationally. Opioid prescribing increased significantly pre-intervention across all 14 NHS Scotland health boards (2.19 items per 1000 population per quarter), followed by a non-significant change in level and a significant negative change in trend post-intervention (-2.69 items per 1000 population per quarter). Similar findings were observed locally in NHS Tayside and NHS Fife. Conclusions: The publication of SIGN 136 coincided with a statistically significant reduction in opioid prescribing rates in Scotland and suggests that changes in clinical policy are having a positive effect on prescribing practices in primary care. These prescribing trends appear to be in contrast to the UK as a whole.

Trends in Opioid Prescribing for Non-Cancer pain and Associated Resource Utilisation in Wales

“…An interrupted TSA was also performed, to assess the impact of a specific intervention, namely the introduction of a national prescribing indicator for 2012 to 2013, which encouraged morphine as the strong opioid of choice (Section 1.11). Effects of the intervention on the number of strong opioid prescriptions issued were examined using the changes in the level and slope of the plotted data-series and their calculated statistical significance (Bernal et al 2017;Hebert et al 2021).…”

“…If so, those problems appear likely to be felt more keenly in the most deprived areas of Wales, where services are more limited or less accessible to those who would most benefit. In Scotland, introducing national prescribing guidelines for pain (SIGN 136) in 2013 has subsequently been associated with an 18.8% reduction in opioid prescribing over the following six years (Hebert et al 2021). An update to their 2013 chronic pain guidelines in 2019, reflected the changes in advice around opioid analgesics.…”